Maintaining high hemoglobin levels improved the left ventricular mass index and quality of life scores in pre-dialysis Japanese chronic kidney disease patients

Hideki Hirakata, Yoshiharu Tsubakihara, Fumitake Gejyo, Shinichi Nishi, Yasuhiko Iino, Yuzou Watanabe, Masashi Suzuki, Akira Saito, Takashi Akiba, Daijo Inaguma, Shunichi Fukuhara, Satoshi Morita, Michiaki Hiroe, Yoshiyuki Hada, Makoto Suzuki, Makoto Akaishi, Kazutaka Aonuma, Tadao Akizawa

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Abstract

Background: Anemia is common among patients with chronic kidney disease (CKD). The introduction of erythropoietin treatment has changed anemia management, but the therapeutic hemoglobin (Hb) target is still under debate, and clinical evidence for its effect on cardiac functions and QOL is sparse. Methods: A 16-week dose-response study and a 32-week follow-Up study were combined. After correcting anemia of less than 10 g/dl in pre-dialysis Japanese CKD patients, a higher Hb target (12-13 g/dl) by darbepoetin alfa (DPO) was compared with the conventional Hb target by epoetin alfa (EPO). Outcomes were anemia correction, management of the left ventricular mass index (LVMI) and QOL scores. Results: No significant difference was seen in Hb at baseline and week 16, but a significant difference was recorded at week 34 (12.34 ± 0.93 g/dl for DPO and 10.43 ± 0.90 g/dl for EPO). In both groups, LVMI decreased similarly until week 16, but the decrease of EPO was retarded, and a significant difference between LVMI was seen only in DPO at week 34 (100.7 ± 16.6 g/m2 for DPO and 110.9 ± 25.2 g/m2 for EPO). Relationships between Hb and LVMI change at week 34 were examined by stratifying Hb into four groups (Hb <10 g/dl, 10 g/dl ≤ Hb <11 g/dl, 11 g/dl ≤ Hb <12 g/dl and 12 g/dl ≤ Hb), and a decrease of LVMI was prominent in the 12 g/dl ≤ Hb group. Correction of anemia to 11 g/dl or more led to improved QOL scores. No safety difference was observed among the treatments. Conclusions: Targeting a higher Hb around 12 g/dl was more beneficial than targeting conventional Hb in terms of reduction of LVMI and QOL. Further studies to determine the appropriate Hb target are necessary.

Original languageEnglish
Pages (from-to)28-35
Number of pages8
JournalClinical and Experimental Nephrology
Volume14
Issue number1
DOIs
Publication statusPublished - 01-02-2010
Externally publishedYes

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Chronic Renal Insufficiency
Dialysis
Hemoglobins
Quality of Life
Epoetin Alfa
Anemia
Erythropoietin
Therapeutics

All Science Journal Classification (ASJC) codes

  • Physiology
  • Nephrology
  • Physiology (medical)

Cite this

Hirakata, Hideki ; Tsubakihara, Yoshiharu ; Gejyo, Fumitake ; Nishi, Shinichi ; Iino, Yasuhiko ; Watanabe, Yuzou ; Suzuki, Masashi ; Saito, Akira ; Akiba, Takashi ; Inaguma, Daijo ; Fukuhara, Shunichi ; Morita, Satoshi ; Hiroe, Michiaki ; Hada, Yoshiyuki ; Suzuki, Makoto ; Akaishi, Makoto ; Aonuma, Kazutaka ; Akizawa, Tadao. / Maintaining high hemoglobin levels improved the left ventricular mass index and quality of life scores in pre-dialysis Japanese chronic kidney disease patients. In: Clinical and Experimental Nephrology. 2010 ; Vol. 14, No. 1. pp. 28-35.
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abstract = "Background: Anemia is common among patients with chronic kidney disease (CKD). The introduction of erythropoietin treatment has changed anemia management, but the therapeutic hemoglobin (Hb) target is still under debate, and clinical evidence for its effect on cardiac functions and QOL is sparse. Methods: A 16-week dose-response study and a 32-week follow-Up study were combined. After correcting anemia of less than 10 g/dl in pre-dialysis Japanese CKD patients, a higher Hb target (12-13 g/dl) by darbepoetin alfa (DPO) was compared with the conventional Hb target by epoetin alfa (EPO). Outcomes were anemia correction, management of the left ventricular mass index (LVMI) and QOL scores. Results: No significant difference was seen in Hb at baseline and week 16, but a significant difference was recorded at week 34 (12.34 ± 0.93 g/dl for DPO and 10.43 ± 0.90 g/dl for EPO). In both groups, LVMI decreased similarly until week 16, but the decrease of EPO was retarded, and a significant difference between LVMI was seen only in DPO at week 34 (100.7 ± 16.6 g/m2 for DPO and 110.9 ± 25.2 g/m2 for EPO). Relationships between Hb and LVMI change at week 34 were examined by stratifying Hb into four groups (Hb <10 g/dl, 10 g/dl ≤ Hb <11 g/dl, 11 g/dl ≤ Hb <12 g/dl and 12 g/dl ≤ Hb), and a decrease of LVMI was prominent in the 12 g/dl ≤ Hb group. Correction of anemia to 11 g/dl or more led to improved QOL scores. No safety difference was observed among the treatments. Conclusions: Targeting a higher Hb around 12 g/dl was more beneficial than targeting conventional Hb in terms of reduction of LVMI and QOL. Further studies to determine the appropriate Hb target are necessary.",
author = "Hideki Hirakata and Yoshiharu Tsubakihara and Fumitake Gejyo and Shinichi Nishi and Yasuhiko Iino and Yuzou Watanabe and Masashi Suzuki and Akira Saito and Takashi Akiba and Daijo Inaguma and Shunichi Fukuhara and Satoshi Morita and Michiaki Hiroe and Yoshiyuki Hada and Makoto Suzuki and Makoto Akaishi and Kazutaka Aonuma and Tadao Akizawa",
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Hirakata, H, Tsubakihara, Y, Gejyo, F, Nishi, S, Iino, Y, Watanabe, Y, Suzuki, M, Saito, A, Akiba, T, Inaguma, D, Fukuhara, S, Morita, S, Hiroe, M, Hada, Y, Suzuki, M, Akaishi, M, Aonuma, K & Akizawa, T 2010, 'Maintaining high hemoglobin levels improved the left ventricular mass index and quality of life scores in pre-dialysis Japanese chronic kidney disease patients', Clinical and Experimental Nephrology, vol. 14, no. 1, pp. 28-35. https://doi.org/10.1007/s10157-009-0212-4

Maintaining high hemoglobin levels improved the left ventricular mass index and quality of life scores in pre-dialysis Japanese chronic kidney disease patients. / Hirakata, Hideki; Tsubakihara, Yoshiharu; Gejyo, Fumitake; Nishi, Shinichi; Iino, Yasuhiko; Watanabe, Yuzou; Suzuki, Masashi; Saito, Akira; Akiba, Takashi; Inaguma, Daijo; Fukuhara, Shunichi; Morita, Satoshi; Hiroe, Michiaki; Hada, Yoshiyuki; Suzuki, Makoto; Akaishi, Makoto; Aonuma, Kazutaka; Akizawa, Tadao.

In: Clinical and Experimental Nephrology, Vol. 14, No. 1, 01.02.2010, p. 28-35.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Maintaining high hemoglobin levels improved the left ventricular mass index and quality of life scores in pre-dialysis Japanese chronic kidney disease patients

AU - Hirakata, Hideki

AU - Tsubakihara, Yoshiharu

AU - Gejyo, Fumitake

AU - Nishi, Shinichi

AU - Iino, Yasuhiko

AU - Watanabe, Yuzou

AU - Suzuki, Masashi

AU - Saito, Akira

AU - Akiba, Takashi

AU - Inaguma, Daijo

AU - Fukuhara, Shunichi

AU - Morita, Satoshi

AU - Hiroe, Michiaki

AU - Hada, Yoshiyuki

AU - Suzuki, Makoto

AU - Akaishi, Makoto

AU - Aonuma, Kazutaka

AU - Akizawa, Tadao

PY - 2010/2/1

Y1 - 2010/2/1

N2 - Background: Anemia is common among patients with chronic kidney disease (CKD). The introduction of erythropoietin treatment has changed anemia management, but the therapeutic hemoglobin (Hb) target is still under debate, and clinical evidence for its effect on cardiac functions and QOL is sparse. Methods: A 16-week dose-response study and a 32-week follow-Up study were combined. After correcting anemia of less than 10 g/dl in pre-dialysis Japanese CKD patients, a higher Hb target (12-13 g/dl) by darbepoetin alfa (DPO) was compared with the conventional Hb target by epoetin alfa (EPO). Outcomes were anemia correction, management of the left ventricular mass index (LVMI) and QOL scores. Results: No significant difference was seen in Hb at baseline and week 16, but a significant difference was recorded at week 34 (12.34 ± 0.93 g/dl for DPO and 10.43 ± 0.90 g/dl for EPO). In both groups, LVMI decreased similarly until week 16, but the decrease of EPO was retarded, and a significant difference between LVMI was seen only in DPO at week 34 (100.7 ± 16.6 g/m2 for DPO and 110.9 ± 25.2 g/m2 for EPO). Relationships between Hb and LVMI change at week 34 were examined by stratifying Hb into four groups (Hb <10 g/dl, 10 g/dl ≤ Hb <11 g/dl, 11 g/dl ≤ Hb <12 g/dl and 12 g/dl ≤ Hb), and a decrease of LVMI was prominent in the 12 g/dl ≤ Hb group. Correction of anemia to 11 g/dl or more led to improved QOL scores. No safety difference was observed among the treatments. Conclusions: Targeting a higher Hb around 12 g/dl was more beneficial than targeting conventional Hb in terms of reduction of LVMI and QOL. Further studies to determine the appropriate Hb target are necessary.

AB - Background: Anemia is common among patients with chronic kidney disease (CKD). The introduction of erythropoietin treatment has changed anemia management, but the therapeutic hemoglobin (Hb) target is still under debate, and clinical evidence for its effect on cardiac functions and QOL is sparse. Methods: A 16-week dose-response study and a 32-week follow-Up study were combined. After correcting anemia of less than 10 g/dl in pre-dialysis Japanese CKD patients, a higher Hb target (12-13 g/dl) by darbepoetin alfa (DPO) was compared with the conventional Hb target by epoetin alfa (EPO). Outcomes were anemia correction, management of the left ventricular mass index (LVMI) and QOL scores. Results: No significant difference was seen in Hb at baseline and week 16, but a significant difference was recorded at week 34 (12.34 ± 0.93 g/dl for DPO and 10.43 ± 0.90 g/dl for EPO). In both groups, LVMI decreased similarly until week 16, but the decrease of EPO was retarded, and a significant difference between LVMI was seen only in DPO at week 34 (100.7 ± 16.6 g/m2 for DPO and 110.9 ± 25.2 g/m2 for EPO). Relationships between Hb and LVMI change at week 34 were examined by stratifying Hb into four groups (Hb <10 g/dl, 10 g/dl ≤ Hb <11 g/dl, 11 g/dl ≤ Hb <12 g/dl and 12 g/dl ≤ Hb), and a decrease of LVMI was prominent in the 12 g/dl ≤ Hb group. Correction of anemia to 11 g/dl or more led to improved QOL scores. No safety difference was observed among the treatments. Conclusions: Targeting a higher Hb around 12 g/dl was more beneficial than targeting conventional Hb in terms of reduction of LVMI and QOL. Further studies to determine the appropriate Hb target are necessary.

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